In New York, retroactive Medicaid can help cover certain healthcare costs from the three months before your application was approved. It’s there to offer some relief for people who applied late or ran into delays they couldn’t control. This kind of coverage can make a real difference, especially when medical bills start to feel overwhelming. If you or a loved one might qualify, it’s worth looking into sooner rather than later. Taking those first steps could mean getting back some of the money spent on hospital stays, doctor visits, or other care during that gap period.
At Schlessel Law PLLC, our experienced Long Island Medicaid planning attorney can help you understand the eligibility requirements, the application process, and the documentation needed to apply. Our team of skilled attorneys is here to guide you through the system and secure the reimbursement you deserve for past medical expenses. Don’t let financial burdens prevent you from accessing essential healthcare services. Contact us today at (516) 574-9630 to learn more about our services and to schedule a consultation.
Is Medicaid Retroactive in New York?
In New York, Medicaid coverage does not begin from the date of application or approval. It has the potential to cover medical expenses incurred up to 90 days before the application was filed. This is particularly beneficial for individuals who may have delayed their Medicaid application due to unawareness or other obstacles.
To take advantage of this retroactive coverage, applicants must meet Medicaid eligibility requirements for the period they seek coverage. This means that during the 90 days prior to the application, the applicant’s income level and other eligibility criteria must align with Medicaid’s standards.
Retroactive coverage isn’t automatic and must be requested by the applicant. This step is crucial and often overlooked. When applying, individuals must indicate their need for retroactive coverage and submit proof of medical expenses incurred during the retroactive period. Doing so can make a substantial difference, potentially eliminating or reducing unpaid medical bills that could lead to financial strain.
Eligibility for retroactive Medicaid in New York provides a financial safety net, ensuring that healthcare needs do not result in overwhelming debt. This program allows eligible individuals and families to seek medical care when needed, knowing that their coverage can extend to past periods, supporting both their health and financial stability.
Long Island Medicaid Planning Attorney – Seth Schlessel
Seth Schlessel
Seth Schlessel is the Managing Member and Founder of Schlessel Law PLLC, a Long Island-based firm focused on elder law, estate planning, and Medicaid planning. Seth works closely with individuals and families to preserve their assets, secure long-term care solutions, and handle the challenges of New York’s Medicaid eligibility rules. He brings compassion and strategic insight to every case, making sure that clients receive guidance tailored to both their financial future and personal values.
Seth graduated from Touro Law School in 2013, where he served in multiple leadership positions, including Vice President of the Sports and Entertainment Society. Since being admitted to the New York Bar in 2014, he has taken pride in handling the firm’s more complicated cases. As both an advocate and a firm leader, Seth is deeply committed to helping Long Island families protect their assets while securing the care they deserve.
Understanding Medicaid Retroactive Coverage
Retroactive Medicaid refers to the provision of healthcare benefits for medical expenses incurred before an individual’s official eligibility start date. It allows eligible individuals to receive reimbursement for costs they have already paid out of pocket.
The process of applying for Medicaid can be complex and time-consuming, making it challenging for individuals to become immediately eligible for coverage. Moreover, when dealing with a serious illness or injury, applying for Medicaid may not be the primary concern. This is where retroactive eligibility comes into play, providing individuals with the opportunity to apply for Medicaid coverage without the immediate worry of how medical bills will be paid.
As long as the applicant meets the eligibility criteria for Medicaid for the three months prior to their application, Medicaid will cover the expenses incurred during that period. It is worth noting that even after an individual’s passing, a retroactive eligibility application can still be filed on their behalf. While some states may only cover unpaid medical expenses, others will reimburse Medicaid recipients for both unpaid and paid bills.
Retroactive coverage ensures that individuals have access to necessary healthcare services, even for conditions or treatments that arose during the retroactive period. This helps prevent delays in receiving timely care and supports individuals’ overall well-being. Retroactive coverage also provides a sense of security and peace of mind, knowing that medical expenses incurred during the retroactive period will be covered, promoting financial stability and health assurance for eligible individuals.
Eligibility Criteria for Retroactive Medicaid
Income Limits and Guidelines
Retroactive Medicaid in New York has specific income limits and guidelines that individuals must meet to qualify. These limits take into account the size of the household and are based on a percentage of the Federal Poverty Level (FPL). In general, the applicant must be eligible for Nursing Home Medicaid, meaning they must be eligible under the New York State guidelines for long-term Medicaid.
To qualify for Nursing Home Medicaid in New York in 2024, an individual must satisfy specific criteria. This includes having an income below $1,732 per month and possessing assets valued at less than $31,175.
Residency Requirements
Eligibility for retroactive Medicaid coverage in New York is contingent upon meeting residency requirements. Individuals must be residents of New York State and provide documentation to prove their residency, such as utility bills or lease agreements.
Age and Disability Criteria
Retroactive Medicaid is available to individuals who meet specific age and disability criteria. For elderly individuals, typically aged 65 or older, proof of age is required. Additionally, individuals with disabilities must provide medical documentation and meet the Social Security Administration’s criteria for disability. The applicant must also meet a functional need for Nursing Home Level of Care, meaning they must need assistance to do daily activities.
Citizenship and Immigration Status
To be eligible for retroactive Medicaid coverage in New York, individuals must be U.S. citizens, U.S. nationals, or qualified immigrants. Proof of citizenship or immigration status, such as a valid passport or green card, is required. A skilled Medicaid planning attorney can assist in verifying your status and ensuring compliance with citizenship and immigration requirements.
Meeting the eligibility criteria can be complicated. Seeking the guidance of a Medicaid planning attorney is essential to ensure that you meet all the necessary requirements and have the best chance of qualifying for retroactive coverage. An attorney can assess your income, residency, age, disability, and immigration status, providing tailored advice and assistance to help you work through the details of the eligibility process.
Can You Apply for Retroactive Medicaid After Someone Dies in NY?
In New York, it is possible to apply for retroactive Medicaid on behalf of a deceased individual. This is often done to help cover unpaid medical bills for care received during the three months before the individual’s Medicaid application date. These retroactive benefits can reduce or eliminate significant debt from the estate.
This type of application can be filed by certain people close to the deceased, including a surviving spouse, an adult child, or the executor or administrator of the estate. While filing after death is allowed, there are additional requirements. You will need to provide documentation that proves the person was eligible for Medicaid during the retroactive period, along with records of any unpaid medical expenses from that time.
Keep in mind that retroactive Medicaid only covers services that Medicaid would normally approve. It does not include transportation-related costs, such as funeral expenses.
Applying after death can be a beneficial financial step for families managing the estate of a loved one. It allows Medicaid to cover eligible services that were not previously paid for, potentially easing the financial burden during a difficult time.
It is recommended that you contact an experienced Long Island Medicaid planning attorney for guidance on the specific documentation required. The process can involve a substantial amount of paperwork, making accuracy from the start essential.
Retroactive Medicaid Coverage Period
Retroactive Medicaid in New York has a specific coverage period that determines the time frame for which individuals can receive retroactive benefits. Generally, the retroactive coverage period starts three months prior to the month of application. This means that eligible individuals may receive reimbursement for medical expenses incurred during this retroactive period. However, it is important to note that the coverage period may vary based on certain circumstances and eligibility factors.
Effective Dates of Coverage
The effective date of Medicaid retroactive coverage is determined by the date of application and eligibility criteria met. If an individual is determined eligible for retroactive coverage, the coverage will typically begin from the start of the retroactive period. It is crucial to submit the application as soon as possible to maximize the potential coverage.
Exceptions and Limita